When his wife spent a week in Georgetown University Hospital's intensive care unit last year recovering from life-saving brain surgery, Joe Huff never worried about who would pay her $120,000 hospital bill, even though his family has no health insurance.

Huff, a 52-year-old Laytonsville, Md. real estate agent, said he trusted that a bill-sharing cooperative of evangelical Christians he joined 10 years ago -- and to which he faithfully mailed a $346 monthly check -- would come through, just as it had when the youngest of the couple's seven children was hospitalized with spinal meningitis two years ago.

After a $250 deductible, Huff said, Christian Care Medi-Share paid for everything. "We also got about 20 cards and letters from people saying they were praying for us," he added.

Huff and his family are among the 60,000 members of Medi-Share, the largest of a little-known group of nonprofit organizations that market themselves as faith-based alternatives to health insurance.

The appeal of these "church plans," as they are known in the insurance industry, is both economic and religious. Because their monthly cost is roughly half that of conventional health insurance premiums, they appeal to those who find medical insurance difficult or impossible to afford. And because their membership is strictly limited to evangelical Christians certified as regular churchgoers by their pastors, they cater to people opposed to "subsidizing high-risk, sinful lifestyles," in the words of Medi-Share's Web site.

"A nonbeliever doesn't have an obligation to follow through" by sending a check each month, said James Lansberry, executive vice president of the 35,000-member Samaritan Ministries International of Peoria, Ill.

All three of the largest plans -- Medi-Share, Samaritan and the Christian Brotherhood Newsletter, headquartered in Barberton, Ohio -- impose strict limits on treatment, restrictions that would be illegal under regulations that apply to conventional insurance.

Tobacco use, immoderate drinking, homosexuality and extramarital sex are strictly forbidden, and anyone caught violating these proscriptions can be expelled.

The plans don't pay for abortion, or treatment of sexually transmitted diseases or HIV that was not, as Samaritan puts it, "contracted innocently."

While each plan's rules differ, most exclude coverage of pre-existing conditions, as well as treatment related to cancer recurrence, serious heart disease, obesity, psychiatric disorders or vision problems.

"Our (members') greatest sin is racing down to the buffet after the sermon," quipped E. John Reinhold, a former insurance executive who is the founding chairman of Medi-Share, a subsidiary of the American Evangelistic Association, based in Melbourne.

Although church plans differ, their basic premise is simple: Members send a monthly check -- a "share" -- ranging from $200 to $400, either to the plan or directly to those the plan designates with "needs," as medical bills are known.

They also agree to send cards and letters or to pray for those in need; in some cases the names and addresses of those in need, along with a brief description of their medical problems, are published in a monthly newsletter.

While Medi-Share has many of the characteristics of insurance -- including annual deductibles, a medical advisory board, the practice of negotiating discounts from hospitals and a requirement that non-emergency treatment be approved -- Reinhold insists it is not insurance and therefore is exempt from state regulation.

Medi-Share, he said, is a voluntary arrangement between like-minded people to share medical expenses according to rules they devise, in fulfillment of the New Testament exhortation that Christians should bear each other's burdens.

Critics disagree. They say Medi-Share and other church plans are essentially unlicensed health insurers operating without regulation, protection for unsuspecting consumers or public accountability. Consumers, they say, may not understand what is not covered, know that they are surrendering their medical privacy or that they could be stuck with huge medical bills.

"These plans function just like health insurance, but they operate in a regulatory black hole," said Mila Kofman, an assistant research professor at Georgetown University's Health Policy Institute. "There is no accountability, no oversight, and the people who participate have no protection." Unlike insurance companies, which are required to have reserve funds to pay claims, church plans do not maintain reserves.

State regulators, Kofman and others say, have been slow to take action because they are leery of the plans' religious affiliations and because complaints by subscribers have been uncommon.

It is operating under a court-ordered receivership imposed in 2000, although the receiver has not supervised the ministry's operations since 2002.

Last year a jury in Akron ruled that its founder, Rev. Bruce Hawthorn, and other former officials defrauded the ministry and ordered them to repay nearly $15 million they spent on luxury houses, motorcycles, expensive cars and high salaries, including one for a stripper whom Hawthorn said in an interview he was "trying to help."

Last year, according to its annual audit, Medi-Share paid nearly $43 million in medical bills, up from $37 million in 2004. In its 12-year existence Medi-Share has paid out about $200 million in medical bills, according to Reinhold.

While many states have investigated church plans in the past 15 years, few have taken action against them, according to the National Association of Insurance Commissioners.

Kentucky regulators are embroiled in a long-running legal battle with Medi-Share. In 2002 the state obtained a restraining order to halt the sale of Medi-Share memberships, which it said was unauthorized insurance. The order was subsequently overturned, but the two sides are still in court.

Matthew Gregory, the 33-year-old pastor of the Soul Purpose Church in Fauquier County, said his family has never had health insurance. They couldn't afford a Blue Cross policy offered through a Southern Baptist group that would have cost $500 per month to cover Gregory, his wife, and their three young sons. The family's annual income is about $40,000. Instead, Gregory pays $225 each month to Samaritan.

At least four times in the past 10 years, Gregory said, his family has sought help paying bills that exceeded $300 -- the plan's minimum allowable claim.

The most recent incident occurred last year when his youngest child, then 4, suffered complications from the West Nile virus and spent nearly two months at the University of Virginia Medical Center in Charlottesville.

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